A victory for liberty

Prosecutors accused Xiulu Ruan of running a pill mill in Alabama that issued nearly 300,000 prescriptions for controlled substances including opioids and benzodiazepines in four years, and Shakeel Kahn of writing prescriptions in exchange for payments. The government argued that the doctors dispensed drugs outside what a “reasonable” doctor would consider proper medical practice.

The doctors argued in defense that they had dispensed the drugs as they believed they were authorized to do under the law. Yet the government claimed that a requirement of scienter—that is, the intent or knowledge of wrongdoing — would make it too hard to convict errant doctors. Lower courts dispensed with this requirement in their jury instructions.

Both doctors were convicted and sentenced to more than two decades in prison. In their appeal, they argued that the government should have been required to prove mens rea—that is, a guilty mind. The Supreme Court ruled unanimously for the doctors.

Writing for the majority, Justice Stephen Breyer notes that the “Government's standard would turn a defendant's criminal liability on the mental state of a hypothetical 'reasonable' doctor, rather than on the mental state of the defendant himself or herself,” adding that the regulatory language defining an authorized prescription is “ambiguous” and “open to varying constructions.”

“The Government argues that requiring it to prove that a doctor knowingly or intentionally acted not as authorized will allow bad-apple doctors to escape liability by claiming idiosyncratic views about their prescribing authority,” Justice Breyer writes; “this kind of argument, however, can be made in many cases imposing scienter requirements, and we have often rejected it.”

Justice Samuel Alito, in a concurrence joined by Justices Clarence Thomas and Amy Coney Barrett, agreed to vacate the convictions. But he wrote that under the language of the law the doctors should have been allowed to make a good-faith defense rather than require the government to prove beyond a reasonable doubt that the defendants knowingly or intentionally acted in an unauthorized manner.

By slapping down the government, the Court is sending a powerful message to prosecutors who often charge unsympathetic defendants with insufficient evidence to prove the accused knew what they were doing was wrong. The ruling could affect prosecutions of opioid distributors and retailers, but the principle applies to other crimes such as fraud.

Despite their ideological differences, the nine Justices agree that the government must prove a defendant knew he was committing a crime. This is crucial to defending against unjust prosecution, and the ruling is a victory for liberty.